Provider Demographics
NPI:1770028284
Name:SALIM A JAFFER MD PC
Entity Type:Organization
Organization Name:SALIM A JAFFER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALIM
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-999-5300
Mailing Address - Street 1:4136 LEGACY PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4265
Mailing Address - Country:US
Mailing Address - Phone:517-999-5300
Mailing Address - Fax:
Practice Address - Street 1:4136 LEGACY PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4265
Practice Address - Country:US
Practice Address - Phone:517-999-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062463207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301062463OtherLICENSE